Please complete the Georgia Veterinary Scholars Program (GVSP) application in full by February 2nd, 2018 at 11:59pm EST. The information that you provide will be used solely for the purpose of processing your application for the GVSP. The ethnic status portion will be used only for reporting required demographic data to our funding agencies. Please note that your application will not be affected in any way if you choose to not answer this question as this information is not provided to application reviewers. All other sections must be filled in completely.
Applicant Information  
Please complete the following information.

Last Name:     First Name: (Legal first name)    Middle Initial:           

Nick Name or Name You Go By:  

If you are affiliated with UGA, enter your MYID:   

Are you, or have you previously been, paid through the UGA payroll system?  

Current Address:  
      
       
    City: State:   Zip:

Permanent Address:
       
      
     City:    State:   Zip:

Cell Phone :   

Email Address:

Gender:   

Date of Birth (enter as mm/dd/yyyy):

Are you a citizen of the United States?  

Do you consider yourself  to be from a disadvantaged socioeconomic background?

Ethnic Status:   
  (Colleges and universities are asked by many entities to describe the racial/ethnic backgrounds of our students and employees. In order to respond to these requests, we ask you to please answer the following optional questions.)
          Do you consider yourself to be Hispanic or Latino/a?

          Regardless of your answer above, please select one or more of the racial categories to describe yourself:  
                
               
               
               
                  


Current Educational Enrollment    
In this section, describe your current educational status.  
   
Current Institution: Class Of:                                
                               Veterinary GPA: First year:  Second year:

GRE Scores:  Verbal:   Quantitative:   Analytical:   Date Taken:   

Educational Background

Will you have completed a bachelor's degree by December 2017?

Will you have completed a master's or PhD degree by December 2017?

Please add all the educational institutions attended and degrees obtained below:

InstitutionLocationDegreeGPAGrad YrActions
------1
-----1
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Questions

The Scholar Program: Explain why you are interested in this opportunity.
   
                                                                       
Your Experience: Describe previous work experience and how it relates to your interest in this program.



Your Career Goals:
What are your career goals at this time and how do you see this program facilitating your efforts to attain these goals?



 References:
 Provide the names, addresses, and email addresses of two references that are familiar with your work performance, at least one reference must be a professor at your veterinary school. Please notify these individuals that they will receive an email which includes a link to provide this information. Please note that your references must complete the reference materials no later than February 8th at 11:59pm EST. Questions can be directed to Jennifer Futter at gvspcvm@uga.edu.  
 
 1. Name:       
     Address:  
     Email Address:       Phone:
    

 2. Name:     
     Address:  
     Email Address:       Phone: 


 



                                                                  



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